Provider Demographics
NPI:1740334093
Name:ELK RIVER CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:ELK RIVER CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:LOHR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:304-364-5225
Mailing Address - Street 1:615 ELK ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1135
Mailing Address - Country:US
Mailing Address - Phone:304-364-5225
Mailing Address - Fax:304-364-8033
Practice Address - Street 1:615 ELK ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1135
Practice Address - Country:US
Practice Address - Phone:304-364-5225
Practice Address - Fax:304-364-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVT32362Medicare UPIN
WV0536942Medicare ID - Type Unspecified